Obese patients tend to have better prostate cancer outcomes

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Patients with metastatic castration-resistant prostate cancer (mCRPC) tend to perform better if they are obese, according to results recently presented at the 36th Annual Meeting of the European Urological Association. This so-called “obesity paradox” has also been observed in other genitourinary cancers in the past.

In an analysis of nearly 1,600 patients included in three phase 3 trials, the overall survival rate (OS) at 36 months was approximately 30% in obese patients, compared with 20% in overweight and overweight patients. normal. Statistical modeling showed that the overall risk of death was 4% lower in obese patients when assessing BMI as a continuous variable, and 29% lower with BMI as a categorical variable.

A person is classified as obese, overweight or of normal weight by their body mass index (BMI), which is calculated by dividing their weight (in kilograms) by their height (in meters) squared. The groupings are:

  • Obese: BMI over 30
  • Overweight: BMI between 25 and 30
  • Normal weight: BMI between 20 and 25

The investigators also determined that the benefit of OS was not caused by the higher dose of chemotherapy received by patients with a higher BMI. They found no interaction between BMI subgroups and chemotherapy dose.

“By examining patients with prostate cancer metastases, we found that obese patients live longer. This means that BMI could be used to predict the survival of these patients,” said Dr Nicola Fossati, researcher under study, urologist at the University of San Raffaele. A press release.

“This obesity paradox has been observed in other cancers, possibly due to the relationship between tissue fat and cancer genomes, and more research is needed in this area. It is also possible that the improvement in survival is due to the interaction of chemotherapy with other drugs Obese patients in this older age group tend to take drugs for other conditions and we do not fully understand how these drugs work. ‘interconnect,’ Fossati added.

“Still, we wouldn’t recommend putting on weight for anyone with this or that disease. Obesity is a risk factor for many cancers and other diseases and patients should always aim for a healthy BMI of 18 to 24. “

The study included 1,577 mCRPC patients included in three phase 3 randomized controlled trials: ASCENT2, MAINSAL and VENICE. The mean age of the patients was 69 years and the median BMI was 28 mg / m2. The median follow-up of survivors was 12 months.

Beyond overall survival, the “obesity effect” has also been observed with cancer-specific survival. Statistical modeling showed that the risk of cancer-related death was 6% lower in obese patients when assessing BMI as a continuous variable, and 35% lower with BMI as a variable. categorial.

“There are many possible explanations for the association of body weight with positive results in metastatic cancers,” said Dr Peter Albers of the University of Düsseldorf, who chairs the scientific congress office of the UAE, in the press release. The BMI is able to better tolerate the toxicity of the treatments and their side effects; in prostate cancer, it could be due to the protective impact of hormones present in fat tissue; and it is known that healthy men with a slightly higher BMI have a longer overall life expectancy compared to very thin ones.

“However, at this time, these are only hypotheses. More research is needed to identify the biological mechanism behind these different findings. Until this mechanism is proven, we cannot recommend any changes in treatment for patients. with advanced prostate cancer, ”added Albers.

A version of this article originally appeared in the Urology Times under the title “Obesity Linked to Improved Survival in Advanced Prostate Cancer”.

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